Compositions and methods for wound healing

ABSTRACT

The present invention is related to the field of wound healing or tissue regeneration due to disease (i.e., for example, cardiovascular diseases, osetoarthritic diseases, or diabetes). In particular, the present invention provides compositions and methods comprising molecules with linked α-gal epitopes for induction of an inflammatory response localized within or surrounding damaged tissue. In some embodiments, the present invention provides treatments for tissue repair in normal subjects and in subjects having impaired healing capabilities, such as diabetic and aged subjects.

FIELD OF INVENTION

The present invention is related to the field of wound healing. Inparticular, the present invention provides compositions and methodscomprising molecules with linked α-gal epitopes for induction of aninflammatory response localized within or surrounding damaged tissue. Insome embodiments, the present invention provides treatments for tissuerepair in normal subjects and in subjects having impaired healingcapabilities, such as diabetic and aged subjects.

BACKGROUND OF THE INVENTION

The inflammatory phase plays a critical role in wound healing regardlessof the cause of the tissue damage. In addition to the destroyinginvading microbes, the inflammatory process is an integral part of thetissue repair process. Neutrophils are the first immune cells to arriveat the wound site where they phagocytose microbial agents and mediatewound debridement. Macrophages migrate into the wound two to three dayspost injury and become the predominant cell population before fibroblastmigration and replication takes place. Compositions and methods toaccelerate the pace and/or extent of wound healing are desirable,particularly in individuals with impaired healing capabilities, such asdiabetic and aged individuals. Thus, there is a need for methods andcompositions that promote healing in both external and internal wounds.

SUMMARY OF THE INVENTION

The present invention is related to the field of wound healing. Inparticular, the present invention provides compositions and methodscomprising molecules with linked α-gal epitopes for induction of aninflammatory response localized within or surrounding damaged tissue. Insome embodiments, the present invention provides treatments for tissuerepair in normal subjects and in subjects having impaired healingcapabilities, such as diabetic and aged subjects.

In some embodiments, the invention relates to a method, comprising:providing a subject having endogenous anti-Gal antibody and a wound; anda preparation comprising an α-gal epitope having a terminal galactosyl;and applying said preparation to said wound to produce a treated wound.In further embodiments, said terminal α-galactosyl is selected from thegroup consisting of Galα1-3Gal, and Galα1-6Gal. In still furtherembodiments, said α-gal epitope is part of a molecule selected from thegroup consisting of a glycolipid, a glycoprotein, and a glycopolymer. Inadditional embodiments, said glycolipid comprises α-gal liposomes. Insome embodiments, said applying is under conditions such that complementactivation within or adjacent to said wound is enhanced. In furtherembodiments, said complement activation comprises production of C5a andC3a. In still further embodiments, said applying is under conditionssuch that neutrophil recruitment within or adjacent to said wound isenhanced. In additional embodiments, said applying is under conditionssuch that monocyte and macrophage recruitment within or adjacent to saidwound is enhanced. In some embodiments, said applying is underconditions such that wound closure is accelerated. In furtherembodiments, the disclosed method is used to treat subjects diagnosedwith or exhibiting symptoms associated with heart disease and damage,arthritis, osetoarthritis, cartilage repair and diabetes mellitus. Instill further embodiments, the disclosed method is used to treat tissueor organ damage in combination with the application of stem cells.

In some embodiments the invention relates to a method, comprising:providing; a subject having a wound; and a wound care device comprisinga preparation comprising an α-gal epitope having a terminalα-galactosyl, and an anti-Gal antibody; and applying said wound caredevice to said wound to produce a treated wound. In further embodiments,said terminal α-galactosyl is selected from the group consisting ofGalα1-3Gal, and Galα1-6Gal. In still further embodiments, said α-galepitope is part of a molecule selected from the group consisting of aglycolipid, a glycoprotein, and a glycopolymer. In additionalembodiments, said glycolipid comprises α-gal liposomes. In someembodiments, said preparation is part of a wound care device selectedfrom the group consisting of adhesive bands, compression bandages, gels,semi-permeable films, and foams. In further embodiments, the disclosedmethod and preparation is used to treat subjects diagnosed with orexhibiting symptoms associated with heart disease and damage, arthritis,osetoarthritis, cartilage repair and diabetes mellitus. In still furtherembodiments, the disclosed method and preparation is used to treattissue or organ damage in combination with the application of stemcells.

In some embodiments, the invention relates to a wound care devicecomprising a preparation comprising an α-gal epitope having a terminalα-galactosyl. In further embodiments, said terminal α-galactosyl isselected from the group consisting of Galα1-3Gal, and Galα1-6Gal. Instill further embodiments, said α-gal epitope is part of a moleculeselected from the group consisting of a glycolipid, a glycoprotein, anda glycopolymer. In additional embodiments, said glycolipid comprisesα-gal liposomes. In some embodiments, said preparation further comprisesanti-Gal antibodies bound to said α-gal liposomes. In furtherembodiments, said device is in the form of one of the group consistingof adhesive bands, compression bandages, gels, semipermeable films, andfoams. In further embodiments, the disclosed device and preparation isused to treat subjects diagnosed with or exhibiting symptoms associatedwith heart disease and damage, arthritis, osetoarthritis, cartilagerepair and diabetes mellitus. In still further embodiments, thedisclosed device and preparation is used to treat tissue or organ damagein combination with the application of stem cells.

In some embodiments, the invention relates to a method, comprising:providing a subject having endogenous anti-Gal antibody and damagedcardiac tissue; and) a preparation comprising an α-gal epitope having aterminal galactosyl; and applying said preparation to said damagedcardiac tissue to produce treated cardiac tissue. In furtherembodiments, said terminal α-galactosyl is selected from the groupconsisting of Galα1-3Gal and Galα1-6Gal. In still further embodiments,said α-gal epitope is part of a molecule selected from the groupconsisting of a glycolipid, a glycoprotein, and a glycopolymer. Inadditional embodiments, said glycolipid comprises α-gal liposomes. Insome embodiments, said applying is under conditions such that complementactivation within or adjacent to said damaged cardiac tissue isenhanced. In further embodiments, said complement activation comprisesproduction of C5a and C3a. In still further embodiments, said applyingis under conditions such that neutrophil recruitment within or adjacentto said damaged cardiac tissue is enhanced. In additional embodiments,said applying is under conditions such that monocyte and macrophagerecruitment within or adjacent to said damaged cardiac tissue isenhanced. In some embodiments, said applying is under conditions suchthat repair of said damaged cardiac tissue is accelerated.

In some embodiments, the invention relates to a method, comprising:providing a subject having endogenous anti-Gal antibody and tissuedamaged by diabetes; and a preparation comprising an α-gal epitopehaving a terminal galactosyl; and applying said preparation to saidtissue damaged by diabetes to produce treated tissue. In furtherembodiments, said terminal α-galactosyl is selected from the groupconsisting of Galα1-3Gal and Galα1-6Gal. In still further embodiments,said α-gal epitope is part of a molecule selected from the groupconsisting of a glycolipid, a glycoprotein, and a glycopolymer. Inadditional embodiments, said glycolipid comprises α-gal liposomes. Insome embodiments, said applying is under conditions such that complementactivation within or adjacent to said tissue damaged by diabetes isenhanced. In further embodiments, said complement activation comprisesproduction of C5a and C3a. In still further embodiments, said applyingis under conditions such that neutrophil recruitment within or adjacentto said tissue damaged by diabetes is enhanced. In additionalembodiments, said applying is under conditions such that monocyte andmacrophage recruitment within or adjacent to said tissue damaged bydiabetes is enhanced. In some embodiments, said applying is underconditions such that repair of said tissue damaged by diabetes isaccelerated.

In some embodiments, the invention relates to a method, comprising:providing a subject having endogenous anti-Gal antibody and tissuedamaged by osteoarthritis; and a preparation comprising an α-gal epitopehaving a terminal galactosyl; and applying said preparation to saidtissue damaged by osteoarthritis to produce treated tissue. In furtherembodiments, said terminal α-galactosyl is selected from the groupconsisting of Galα1-3Gal and Galα1-6Gal. In still further embodiments,said α-gal epitope is part of a molecule selected from the groupconsisting of a glycolipid, a glycoprotein, and a glycopolymer. Inadditional embodiments, said glycolipid comprises α-gal liposomes. Insome embodiments, said applying is under conditions such that complementactivation within or adjacent to said tissue damaged by osteoarthritisis enhanced. In further embodiments, said complement activationcomprises production of C5a and C3a. In still further embodiments, saidapplying is under conditions such that neutrophil recruitment within oradjacent to said tissue damaged by osteoarthritis is enhanced. Inadditional embodiments, said applying is under conditions such thatmonocyte and macrophage recruitment within or adjacent to said tissuedamaged by osteoarthritis is enhanced. In some embodiments, saidapplying is under conditions such that repair of said tissue damaged byosteoarthritis is accelerated. In further embodiments, said tissuedamaged by osteoarthritis is selected from the group consisting of boneand cartilage.

BRIEF DESCRIPTION OF THE DRAWINGS

The following are illustrations of the present invention and are notintended to limit the scope of the invention in any manner.

FIG. 1A shows an interaction of an α-gal liposome with anti-Gal IgG andIgM antibodies. FIG. 1B illustrates an interaction between an anti-Galcoated (opsonized) α-gal liposome and a macrophage.

FIG. 2 shows the components of α-gal liposomes prepared from rabbit redblood cell (RBC) membranes. FIG. 2A depicts the separation of rabbit RBCglycolipids, phospholipids and cholesterol by thin layer chromatography(TLC), as demonstrated by nonspecific orcinol staining (left lane) andby immunostaining with an anti-Gal monoclonal antibody (mAb) designatedGal-13 (right lane) (Galili et al., J Biol Chem, 262:4683, 1987). Thesmallest glycolipids having three carbohydrates (ceramide tri-hexoside[CTH]) lack α-gal epitopes and thus are not stained by the anti-Gal mAb.The number of carbohydrates in each α-gal glycolipid is indicated on theright. The smallest α-gal-containing glycolipid has five carbohydrates(ceramide pentahexoside [CPH]). FIG. 2B provides the structures of α-galglycolipids having five, seven, 10, 15 and 20 carbohydrates,respectively.

FIG. 3 shows the binding of anti-Gal to α-gal liposomes either in an invitro suspension or in a solid-phase antigen in an enzyme-linkedimmunosorbent assay (ELISA). FIG. 3A shows a graph of the binding ofanti-Gal to α-gal liposomes in suspension as demonstrated byneutralization of anti-Gal in human serum. Serum was incubated with 10mg/ml α-gal liposomes for 2 h at 37° C. Subsequently, the serum wasplaced in ELISA wells (in serial two-fold dilutions starting at a serumdilution of 1:10) coated with synthetic α-gal epitopes linked to bovineserum albumin (α-gal BSA) as the solid-phase antigen. The anti-Galwithin the serum that was not neutralized by the α-gal liposomes boundto the α-gal BSA-coated wells. Binding of anti-Gal to α-gal BSA wasdetermined by the subsequent binding of rabbit anti-human IgG coupled tohorseradish peroxidase (HRP) and color development with O-phenylenediamine (OPD). Human serum incubated in the presence (●) or absence (◯)of α-gal liposomes is shown. FIG. 3B shows a graph of the binding ofserum anti-Gal to α-gal liposomes as solid-phase antigen. α-Galliposomes (100 μg/ml) in phosphate buffered saline (PBS) were dried inELISA wells. After blocking with 1% BSA in PBS, the α-gal epitopes onα-gal liposomes in control wells were specifically removed from theglycolipids carbohydrate chains by incubation for 1 h at 37° C. with 10units/ml recombinant α-galactosidase (α-galase). Anti-Gal readily bindsto α-gal epitopes on the α-gal liposomes, and is evident even at a serumdilution of 1:320 (●). Elimination of the terminal α-galactosyl unit byα-galactosidase results in complete elimination of the binding even at aserum dilution of 1:20 (◯). Anti-Gal binding was evident in KO mouseserum dilution of 1:1280 (▪), whereas treatment of α-gal liposomes withα-galactosidase resulted in elimination of >99% of anti-Gal binding (□).Similarly, the anti-Gal monoclonal antibody (mAb) M86 bound effectivelyto the α-gal liposomes (♦). No significant binding was observed in wellstreated with α-galactosidase (⋄). The lectin Bandeiraea simplicifoliaIB4 (BS lectin with starting concentration of 10 μg/ml) that bindsspecifically to α-gal epitopes was observed to bind to α-gal liposomes(▴), but not to these liposomes after they were treated withα-galactosidase (Δ).

FIG. 4 shows the activation of human complement or rabbit complement byhuman anti-Gal binding to α-gal epitopes on α-gal liposomes. FIG. 4Ashows a schematic for complement activity involving the lysis of theanti-Gal producing hybridoma cells M86. FIG. 4B provides a graph ofshowing the lysis of M86 cells by complement after incubation at 37° C.for 1 h. FIG. 4C provides a graph showing that interaction of humanserum anti-Gal with α-gal liposomes results in complement consumption asmeasured by a loss of serum lytic activity. Human serum at a dilution of1:10 was co-incubated with α-gal liposomes at various concentrations ofthe liposomes for 2 h at 37° C.

FIG. 5 shows the migration of human monocytes and neutrophils, or ofmouse macrophages in response to chemotactic gradients generated bycomplement activation following anti-Gal binding to α-gal liposomes. Theanalysis was performed in a Boyden chamber system. This system includestwo chambers, with the lower chamber containing human serum mixed withα-gal liposomes and the upper chamber containing various peripheralblood mononuclear cells (PBMC) or polymorphonuclear cells (PMN). The twochambers are separated by a porous filter (e.g., 8 μm pores), whichpermits the migration of cells between the chambers. The size of themigration area is 18 mm². After 24 h at 37° C. the filters were washedand stained, and the number of cells migrating toward the lower chamberwere counted. The study was performed with 1×10⁶ cells/ml in the upperchamber and serum diluted 1:5 and 1:10, mixed with 1 mg/ml of α-galliposomes, in the lower chamber. Open columns indicate the number ofmigrating cells in the absence of serum; closed columns indicate thenumber of migrating cells with serum dilution 1:5; and gray columnsindicate the number of migrating cells with serum dilution 1:10.

FIG. 6 depicts the in vivo induction of local inflammation byintradermal injection of α-gal liposomes in KO mice. The KO mice wereimmunized three times intraperitoneally with a homogenate of 50 mg pigkidney membranes to induce anti-Gal production. The KO mice wereinjected intradermally with 1 mg α-gal liposomes suspended in 0.1 mlsaline, and euthanized at different time points post-injection. Skinspecimens at the injection site were removed, sectioned, stained withhematoxyllin-eosin (H&E) and inspected microscopically. Some of thesections include the epidermis layer as point of reference. FIG. 6Ashows untreated skin with the epidermis containing one or two layers ofepithelial cells, and the dermis containing fibroblasts and fat cells(×100). FIG. 6B shows skin 12 hours post-injection (×100). FIG. 6C showsskin 12 h post-injection with the injection site at the center of thefigure (×100). FIG. 6D shows skin 12 h post-injection (×400). Highermagnification of the infiltrating inflammatory cells indicates that thecells are neutrophils, based on the morphological characteristics oftheir nuclei. FIG. 6E shows skin 48 h post-injection (×400). Theinfiltrating inflammatory cells at this time point are mononuclear cellswith characteristics of macrophages, as indicated by the kidney shape ofmany of these cells. FIG. 6F shows skin five days post-injection (×100).Most macrophages assume a round morphology because of internalization ofnumerous α-gal liposomes. The area in the center of the injection siteis devoid of cells and is functioning as an α-gal liposome depot. FIG.6G shows skin 14 days post-injection (×100) with macrophages stillvisible in area of the injection site. FIG. 6H shows skin 20 dayspost-injection (×100). The injection area contains many myofibroblastsdifferentiating into fibroblasts or muscle cells, and almost nomacrophages are observed within the injected area.

FIG. 7 provides a graph depicting the lack of antibody response toinjected α-gal liposomes. The antibody response was measured in an ELISAwith 50 μl of α-gal liposomes at concentration of 100 μg/ml dried ineach well (solid phase antigen). The dried α-gal liposomes weresubsequently blocked with 1% BSA in PBS. Serum samples from tworepresentative mice obtained before and 35 days post intradermalinjection (◯, ● and □, ▪), were tested for IgG binding to α-galliposomes. No significant differences are observed in anti-α-galliposomes IgG antibody activity in serum from mice obtained post α-galliposome injection (closed symbols).

FIG. 8 provides exemplary data demonstrating in vivo recruitment ofmacrophages into polyvinyl alcohol (PVA) sponge containing α-galliposomes. The sponge filled by soaking with α-gal liposome suspension(100 mg/ml) was implanted subcutaneously in α-1,3-galactosyltransferaseknockout mice (KO mice) for 3 days, then removed. The infiltrating cellswere obtained by repeated squeezing of the sponge in 1 ml PBS. The cellswere stained with anti-CD11b antibody (Pharmingen, Inc,) thatspecifically binds to macrophages and allows for the identification ofmacrophages by flow cytometry (FACS) analysis. Solid line-isotypecontrol of cells stained only with the secondary FITC coupled anti-ratIgG antibody. Broken line-cells stained with monoclonal rat anti-mouseCD11b Ab, then with secondary fluorescein coupled anti-rat IgG antibody.Note the shift of the whole cell population to the right, implying thatall cells migrating into the PVA sponge containing α-gal liposomes, aremacrophages. A representative mouse is shown.

FIG. 9 illustrates one embodiment of an interaction between anti-Gal andα-gal epitopes on α-gal glycolipids applied in the form of α-galointment. The α-gal ointment, comprised here of a mixture of α-galglycolipids (100 mg/ml) and petrolatum ointment (Vaseline), is appliedtopically on areas of damaged skin such as burns, in which serumproteins including anti-Gal and complement are released from damagedblood vessels. The α-gal epitopes (Galα1-3Galβ1-4GlcNAc-R) indicated onsome of the chains in rectangles of broken lines) are present on allrabbit red cell glycolipids that carry 5 or more carbohydrate units (seeFIG. 2). The present figure illustrates a representative α-galglycolipid with 10 carbohydrate units. The fatty tail comprising theceramide portion of the glycolipid enables mixing of the α-galglycolipids within petrolatum (Vaseline) containing hydrocarbon chainsof >25 carbons. α-Gal glycolipids within the ointment bind anti-Gal andthus, activate complement. The complement cleavage factors C5a and C3arecruit macrophages which mediate the accelerated natural process ofwound healing.

FIG. 10 demonstrates one embodiment of an interaction between ananti-Gal antibody and α-gal glycolipids within α-gal ointment.Neutralization of monoclonal anti-Gal following mixing with α-galointment (◯), or Vaseline control lacking α-gal glycolipids (●).Anti-Gal activity was determined by subsequent binding to α-gal epitopeslinked to BSA (α-gal BSA) as solid phase antigen in ELISA wells.

FIG. 11 provides exemplary data showing the effects of α-gal ointment onhealing of burns induced by thermal injury to the skin.α1,3galactosyltransferase KO mice confirmed to produce anti-Gal intiters comparable to those in humans, were anesthetized and two burnswere made on their backs by thermal injury with the heated bend end of asmall metal spatula. One burn (left) was covered with Vaseline and theother (right) with α-gal ointment comprised of α-gal glycolipids mixedwith Vaseline. Subsequently, burns were covered with small roundband-aids. After six days the band-aids were removed from the burns. Asshown in (A), the burn treated with α-gal ointment healed significantlyfaster than that with Vaseline and its size was ˜50% of the Vaselinetreated burn. Histological analysis of these burns demonstrated in theVaseline treated burn (B) that the dermis was not covered by epidermisto replace the tissue damaged by the burn. The dark fragments on theskin are the damaged epidermis in the form of debris (crust) coveringthe wound and referred to as “eschar”. The α-gal ointment treated wound(C) also has eschar caused by the burn. However, the skin is covered bya new multilayered epidermis comprised of epithelial cells covered bythe keratinous layer (stratum corneum, stained-pink). Data are of one of4 mice with similar results.

DEFINITIONS

To facilitate an understanding of the present invention, a number ofterms and phrases are defined below:

The term “α-gal epitope” as used herein, refers to any molecule, or partof a molecule, with a terminal structure comprisingGalα1-3Galβ1-4GlcNAc-R, Galα1-3Galβ1-3GlcNAc-R, or any carbohydratechain with terminal Galα1-3Gal at the non-reducing end, or any moleculewith terminal α-galactosyl unit capable of binding the anti-Galantibody.

The term “glycolipid” as used herein, refers to any molecule with atleast one carbohydrate chain linked to a ceramide, or a fatty acidchain, or any other lipid. Alternatively, a glycolipid maybe referred toas a glycosphingolipid.

The term “α-gal ointment” as used herein, refers to any ointment ofhydrocarbon base or any other base that contains α-gal epitopes in afree form or α-gal epitopes in α-gal glycolipids, α-gal proteins, orα-gal polymers.

As used herein, the term “purified” refers to molecules(polynucleotides, or polypeptides, or glycolipids) that are removed fromtheir natural environment, isolated or separated. “Substantiallypurified” molecules are at least 50% free, preferably at least 75% free,more preferably at least 90% and most preferably at least 95% free fromother components with which they are naturally associated.

The terms “α1,3-galactosyltransferase,” “α-1,3-galactosyltransferase,”“α1,3GT,” “glycoprotein α-galactosyltransferase 1” and “GGTA1,” as usedherein refer to any enzyme capable of synthesizing α-gal epitopes. Theenzyme is expressed in most mammals with the exception of humans, apesand Old World monkeys. The carbohydrate structure produced by the enzymeis immunogenic in man and most healthy people have high titer naturalanti α-gal antibodies, also referred to as “anti-Gal” antibodies. Insome embodiments, the term “α1,3GT” refers to a common marmoset gene(e.g., Callithrix jacchus—GENBANK Accession No. S71333) and its geneproduct, as well as its functional mammalian counterparts (e.g., otherNew World monkeys, prosimians and non-primate mammals, but not Old Worldmonkeys, apes and humans). The term “α1,3GT” is in no way limited to aparticular mammal, for example, the term may include mouse α1,3GT (e.g.,Mus musculus—nucleotides 445 to 1560 of GENBANK Accession No.NM_(—)010283), bovine α1,3GT (e.g., Bos taurus—GENBANK Accession No.NM_(—)177511), feline α1,3GT (e.g., Felis catus—GENBANK Accession No.NM_(—)001009308), ovine α1,3GT (e.g., Ovis aries—GENBANK Accession No.NM_(—)001009764), rat α1,3GT (e.g., Rattus norvegicus—GENBANK AccessionNo. NM_(—)145674) and porcine α1,3GT (e.g., Sus scrofa—GENBANK AccessionNo. NM_(—)213810). Some embodiments of the present invention comprise afunctional variant of a mammalian α1,3GT, which differs from the wildtype mammalian α1,3GT sequences in, for example, fewer than 1-5% of theresidues. α1,3GT variants include but are in no way limited to naturallyoccurring, functional mammalian α1,3GT variants, as well asnon-naturally occurring variants generated by recombinant or other means(e.g., 1, 2, 3, 4 or 5 amino acid substitutions, deletions, oradditions, preferably corresponding to a residue from a functionalmammalian α1,3GT homolog) are contemplated to find use in thecompositions and methods of the present invention. In other embodiments,truncated forms of a mammalian α1,3GT, which retain catalytic activity,are employed (e.g., GGTA1 lacking 90 amino acid N-terminal stem region).

The term “anti-Gal binding epitope”, as used herein, refers to anymolecule or part of molecule that is capable of binding in vivo thenatural anti-Gal antibody.

The term “isolated” as used herein, refers to any composition or mixturethat has undergone a laboratory purification procedure including, butnot limited to, extraction, centrifugation and chromatographicseparation (e.g., thin layer chromatography or high performance liquidchromatography). Usually such a purification procedures provides anisolated composition or mixture based upon physical, chemical, orelectrical potential properties. Depending upon the choice of procedurean isolated composition or mixture may contain other compositions,compounds or mixtures having similar chemical properties.

The term “control” refers to subjects or samples which provide a basisfor comparison for experimental subjects or samples. For instance, theuse of control subjects or samples permits determinations to be maderegarding the efficacy of experimental procedures. In some embodiments,the term “control subject” refers to animals, which receive a mocktreatment (e.g., saline).

The term “diabetic” as used here refers to organisms which have adisorder characterized by the insufficient production or utilization ofinsulin. Insulin is a pancreatic hormone that is needed to convertglucose for cellular metabolism and energy production. In preferredembodiments of the present invention, the term “diabetic patient” refersto patients suffering from diabetes mellitus. The term “diabetic”encompasses both patients with type I diabetes (juvenile onset) andpatients with type II diabetes (adult onset). “Type I diabetes” alsoreferred to as “insulin-dependent diabetes” is a form of diabetesmellitus that usually develops during childhood or adolescence and ischaracterized by a severe deficiency in insulin secretion resulting fromatrophy of the islets of Langerhans and causing hyperglycemia and amarked tendency towards ketoacidosis. “Type II diabetes” also referredto as “non-insulin-dependent diabetes” is a form of diabetes mellitusthat develops especially in adults (most often in obese individuals) andthat is characterized by hyperglycemia resulting from bothinsulin-resistance and an inability to produce more insulin.

The term “aged” as used herein refer to older human subjects (e.g.,middle age and above of 50 years and older, senior citizen and above of65 years and older, or elderly and above of 80 years and older, etc.).The term “aged” also encompass older nonhuman mammalian subjects atsimilar stages in their life cycles (e.g., 8-12 years and older for catsand large dogs, 10-15 years and older for small and medium sized dogs,15-18 months and older for mice, etc.)

The terms “patient” and “subject” refer to a mammal or an animal that isa candidate for receiving medical treatment.

As used herein, the term “wound” refers to a disruption of the normalcontinuity of structures caused by a physical (e.g., mechanical) force,a biological (e.g., thermic or actinic force, or a chemical means. Inparticular, the term “wound” encompasses wounds of the skin. The term“wound” also encompasses contused wounds, as well as incised, stab,lacerated, open, penetrating, puncture, abrasions, grazes, burns,frostbites, corrosions, wounds caused by ripping, scratching, pressure,and biting, and other types of wounds. In particular, the termencompasses ulcerations (i.e., ulcers), preferably ulcers of the skin.

As used herein, the term “wound healing” refers to a regenerativeprocess with the induction of an exact temporal and spatial healingprogram comprising wound closure and the processes involved in woundclosure. The term “wound healing” encompasses but is not limited to theprocesses of granulation, neovascularization, fibroblast, endothelialand epithelial cell migration, extracellular matrix deposition,re-epithelialization, and remodeling.

The term “wound closure” refers to the healing of a wound wherein sidesof the wound are rejoined to form a continuous barrier (e.g., intactskin).

The term “granulation” refers to the process whereby small, red,grain-like prominences form on a raw surface (that of wounds or ulcers)as healing agents.

The term “neovascularization” refers to the new growth of blood vesselswith the result that the oxygen and nutrient supply is improved.Similarly, the term “angiogenesis” refers to the vascularization processinvolving the development of new capillary blood vessels.

The term “cell migration” refers to the movement of cells (e.g.,fibroblast, endothelial, epithelial, etc.) to the wound site.

The term “extracellular matrix deposition” refers to the secretion bycells of fibrous elements (e.g., collagen, elastin; reticulin), linkproteins (e.g., fibronectin, laminin), and space filling molecules(e.g., glycosaminoglycans). As used herein, the term “type I collagen”refers to the most abundant collagen, which forms large well-organizedfibrils having high tensile strength.

The term “re-epithelialization” refers to the reformation of epitheliumover a denuded surface (e.g., wound).

The term “remodeling” refers to the replacement of and/ordevascularization of granulation tissue.

The term “impaired healing capabilities” comprises wounds, which arecharacterized by a disturbed wound healing process. Examples of woundswith impaired healing capabilities are wounds of diabetic patients andalcoholics, wounds which are infected by microorganisms, ischemicwounds, wounds of patients suffering from deficient blood supply orvenous stasis, and ulcers. Particularly preferred wounds are diabeticwounds. Other preferred wounds include wounds of elderly subjects andchronic wounds of subjects of any age.

As used herein, the term “chronic wound” refers to a wound that does notfully heal even after a prolonged period of time (e.g., 2 to 3 months orlonger).

The term “diabetic wounds” refers to wounds of mammals and humanssuffering from diabetes. An example of a diabetic wound is an ulcer(e.g., Ulcus cruris arteriosum or Necrobiosis lipoidica).

As used herein, the term “ulcer” (i.e., “ulceration”) refers to a localdefect or excavation of the surface of an organ or tissue, produced bysloughing of necrotic tissue. The term encompasses various forms ofulcers (e.g., diabetic, neuropathic, arterial, decubitus, dental,perforating, phagedenic, rodent, trophic, tropical, varicose, venereal,etc.), although in preferred embodiments, surface (i.e., skin) ulcersare involved in the present invention. Especially preferred ulcers arediabetic ulcers.

In some embodiments, the present invention provides methods andcompositions for “accelerating wound healing,” whereby different aspectsof the wound healing process are “enhanced.” As used herein, the term“enhanced” indicates that the methods and compositions provide anincreased rate of wound healing. In preferred embodiments, the term“enhanced” indicates that the wound healing rate and/or a wound healingprocess occurs at least 10% faster than is observed in untreated orcontrol-treated wounds. In particularly preferred embodiments, the term“enhanced” indicates that the wound healing rate and/or a wound healingprocess occurs at least 15% faster than is observed in untreated orcontrol-treated wounds. In still further preferred embodiments, the term“enhanced” indicates that the wound healing rate and/or a wound healingprocess occurs at least 20% (e.g., 50%, 100%, . . . ) faster than woundsuntreated or control-treated wounds.

As used herein, the terms “localized” and “local” refer to theinvolvement of a limited area. Thus, in contrast to “systemic”treatment, in which the entire body is involved, usually through thevascular and/or lymph systems, localized treatment involves thetreatment of a specific, limited area. Thus, in some embodiments,discrete wounds are treated locally using the methods and compositionsof the present invention.

As used herein, the term “topically” means application to the surface ofthe skin, mucosa, viscera, etc. Similarly, the terms “topically activedrug” and “topically active agent” refer to a substance or composition,which elicits a pharmacologic response at the site of application (e.g.,skin), but is not necessarily an antimicrobial agent.

As used herein, the term “medical devices” includes any material ordevice that is used on, in, or through a patient's body in the course ofmedical treatment for a disease or injury. Medical devices include, butare not limited to, such items as medical implants, wound care devices,drug delivery devices, and body cavity and personal protection devices.The medical implants include, but are not limited to, urinary catheters,intravascular catheters, dialysis shunts, wound drain tubes, skinsutures, vascular grafts, implantable meshes, intraocular devices, heartvalves, and the like.

As used herein, “wound care devices” include, but are not limited toconventional materials such as dressings, plasters, compresses,ointments containing the pharmaceuticals, or gels containing thepharmaceuticals that can be used in accordance with the presentinvention. Thus, it is possible to administer the wound care devicescomprising α-gal epitopes or α-gal epitopes and anti-Gal antibodiestopically and locally in order to exert an immediate and direct effecton wound healing. The topical administration of wound care devices canbe effected, for example, in the form of a solution, an emulsion, acream, an ointment, a foam, an aerosol spray, a gel matrix, a sponge,drops or washings. Suitable additives or auxiliary substances areisotonic solutions, such as physiological sodium chloride solutions orsodium alginate, demineralized water, stabilizers, collagen containingsubstances such as Zyderm II or matrix-forming substances such aspovidone. To generate a gel basis, formulations, such as aluminumhydroxide, polyacrylacid derivatives, and cellulose derivatives (e.g.,carboxymethyl cellulose) are suitable. These gels can be prepared ashydrogels on a water basis or as oleogels with low and high molecularweight paraffines or Vaseline and/or yellow or white wax. As emulsifieralkali soaps, metal soaps, amine soaps or partial fatty acid esters ofsorbitants can be used, whereas lipids can be added as Vaseline, naturaland synthetic waxes, fatty acids, mono-, di-, triglycerides, paraffin,natural oils or synthetic fats. The wound care devices comprising α-galepitopes and anti-Gal antibodies according to the invention can also,where appropriate, be administered topically and locally, in the regionof the wound, in the form of liposome/antibody complexes, or complexesbetween any antigen and its corresponding antibody, or complementactivating substances.

Furthermore, the treatment can be effected using a transdermaltherapeutic system (TTS), which enables the pharmaceuticals of thepresent invention to be released in a temporally controlled manner. Toimprove the penetration of the administered drug through the membrane,additives such as ethanol, urea or propylene glycol can be added inaddition to polymeric auxiliaries.

DETAILED DESCRIPTION OF THE INVENTION

The present invention is related to the field of wound healing. Inparticular, the present invention provides compositions and methodscomprising molecules with linked α-gal epitopes for induction of aninflammatory response localized within or surrounding damaged tissue. Insome embodiments, the present invention provides treatments for tissuerepair in normal subjects and in subjects having impaired healingcapabilities, such as diabetic and aged subjects.

In some embodiments, the invention relates to methods and compositionsfor the promotion of wound healing. Macrophages play a major role in thesuccess of wound healing in part by generation of reactive radicals suchas nitric oxide and oxygen peroxide, and through the secretion ofcollagenase and elastase as provided for in Bryant et al., Prog. Clin.Biol. Res. 266, 273 (1988) and Knighton et al., Prog. Clin. Biol. Res.299, 217 (1989), both of which are hereby incorporated by reference.Macrophages secrete cytokines and growth factors that are essential inrecruitment of macrophages, lymphocytes, mesenchimal stem cells andfibroblasts into the wound site. Cytokines and growth factors alsoregulate fibroblast and epithelial cell proliferation, as well asproliferation of endothelial cells for revascularization as disclosed inRappolee et al., Curr. Top. Microbiol. Immunol. 181, 87 (1992) andNathan, J. Clin. Invest. 79, 319 (1987), both of which are herebyincorporated by reference. Accordingly, experiments inmacrophage-depleted animals have been associated with defects in woundhealing as provided for in Leibovich and Ross, Am. J. Pathol. 78, 71(1975), incorporated in its entirety by reference.

Accelerated wound healing and improved repair and remodeling of damagedtissues is contemplated to be achievable by effectively controllingrecruitment of monocytes and differentiation of these cells intoactivated macrophages. Activated macrophages in turn secrete fibrogenicand angiogenic growth factors inducing formation of granulation tissuecontaining myofibroblasts as described in Frangogiannis, Curr. Med.Chem. 13, 1877 (2006), incorporated herein by reference, andangiogenesis associated with local collagen synthesis andre-epithelization as provided for in Stein et al., Clin. Exp. Allergy22, 19 (1992); DiPietro, Shock 4, 233 (1995); Clark, J. Dermatol. Surg.Oncol. 19, 693 (1993) and Rappolee et al., Curr. Topics MicrobialImmunol. 181, 87 (1992), all of which are hereby incorporated byreference. Macrophages have key functions in almost every stage of thewound healing, tissue repair and remodeling processes. Upon initiationof the inflammatory stage, macrophages secrete interleukin-1 (IL-1),which induces the rapid recruitment of inflammatory cells from thecirculation into the wound as provided for in Dinarello, FASEB J. 2, 108(1988), incorporated in its entirety by reference. As phagocytes, themacrophages aid in the digestion of bacteria and cell debris asdescribed in Aderem et al., Ann. Rev. Immunol. 17, 593 (1999),incorporated herein by reference. In later stages, macrophages secreteinterleukin-6 (IL-6), which influences endothelial cell proliferationand initiation of angiogenesis as discussed in Mateo et al., Am. J.Physiol. 266, R1840 (1994), hereby incorporated by reference.Macrophages further coordinate cellular proliferation by production ofgrowth factors such as α and β vascular endothelial cell growth factors(VGEF), epidermal growth factor (EGF), fibroblast growth factor (FGF)and insulin-like growth factor (IGF) as provided for in Singer et al.,New England Journal of Medicine 341, 738 (1999), incorporated herein byreference. Moreover, local administration of in vitro activatedmacrophages into ulcerated wounds, or into wounds resulting frominfections following open heart surgery, was found to accelerate thewound healing process as described in Danon et al., Exp. Gerontol. 32,633 (1997) and Orensterin et al., Wound Repair Regen. 13, 237 (2005),both of which are incorporated in their entirety by reference.

In some embodiments, the present invention provides for compositions andmethods for using the anti-Gal antibody for the recruitment and localactivation of neutrophils, monocytes and macrophages within and adjacentto wounded tissue. This is achieved by administration of compositionscomprising liposomes bearing multiple α-gal epitopes(Galα1-3Galβ1-(3)4GlcNAc-R) as part of the glycolipid component. Theanti-Gal antibody, which constitutes 1% of immunoglobulins in humans,apes, Old World primates and birds, interacts specifically with α-galepitopes. In situ binding of anti-gal to α-gal epitopes on α-galglycolipids and to other molecules carrying this epitope, results inlocal activation of complement and generation of the chemotactic factorsC5a and C3a. These factors direct migration of neutrophils followed bymonocytes and macrophages into the injection site. These inflammatoryinfiltrates are suitable for combating microbes within infected wounds.In addition, the monocytes and macrophages infiltrates are contemplatedto bind by their Fey receptors, anti-Gal antibodies via the Fc portionof anti-Gal opsonizing the α-gal liposomes, thereby and activating thesecells. This in turn induces the uptake of the anti-Gal opsonized α-galliposomes and the secretion of cytokines and growth factors thataccelerate wound healing. As such treatment regimens comprising α-galliposomes administration within and/or adjacent to a wound arecontemplated to result in accelerated healing and improved repair ofdamaged tissues. Alternatively, topical application of ointmentcontaining α-gal glycolipids (referred to as α-gal ointments) results insimilar binding of anti-Gal to α-gal glycolipids, complement activation,chemotactic migration of neutrophils, monocytes and macrophages into thetreated area, local secretion of cytokines and growth factors thatcontribute to accelerated wound healing.

When a wound occurs to the skin, the cells must work to close the breachand re-establish the barrier to the environment. The process of woundhealing typically consists of three phases during which the injuredtissue is repaired, regenerated, and new tissue is reorganized into ascar. These three phases can be classified as: a) an inflammation phasewhich begins on day 0 and lasts up to 3 days; b) a cellularproliferation phase from 3 to 12 days; and c) a remodeling phase from 3days to about 6 months.

In the inflammation phase, inflammatory cells, mostly neutrophils, enterthe site of the wound followed by lymphocytes, monocytes, and latermacrophages. Stimulated neutrophils release proteases and reactiveoxygen species into the surrounding medium, with potential adverseeffects on both the adjacent tissues and the invading microorganisms.The proliferative phase consists of laying down new granulation tissue,and the formation of new blood vessels in the injured area. Fibroblasts,endothelial cells, and epithelial cells migrate to the wound site. Thesefibroblasts produce the collagen necessary for wound repair. Inre-epithelialization, epithelial cells migrate from the free edges ofthe tissue across the wound. This event is succeeded by theproliferation of epithelial cells at the periphery of the wound. Ingeneral, re-epithelialization is enhanced by the presence of occlusivewound dressings that maintain a moisture barrier. Remodeling, the finalphase of wound healing, is effected by both the replacement ofgranulation tissue with collagen and elastin fibers and thedevascularization of the granulation tissue. Eventually, in most cases,a scar forms over the wounded area.

I. The Role of Inflammatory Cells in Wound Healing and Tissue Repair

Neutrophils are the first immune cells to arrive at the wound siteappearing approximately 24 h after injury. They phagocytose bacteria andmediate wound debridement. Macrophages migrate into the wound 48-96 hafter injury and become the predominant cells within the inflammatoryresponse in the wound. Studies on depletion of monocytes and/ormacrophages in mice by intravascular administration of specificanti-macrophage antibodies have indicated that wound healing is impairedafter depletion of these cells as provided for in Leibovich et al., Am.J. Pathol. 78, 71 (1975), incorporated herein by reference. In contrast,depletion of granulocytes, including neutrophils, through the use ofspecific anti-granulocyte antibodies does not hamper the inflammatoryresponse and subsequent wound healing and tissue repair as provided forin Leibovich et al., Am. J. Pathol. 78, 71 (1975), incorporated hereinby reference. This result suggests that cells of the monocyte/macrophagelineage are pivotal in orchestrating wound healing and tissue repair andin remodeling following injury. As such the present invention providescompositions and methods for inducing rapid recruitment of macrophagesinto wounds and injured tissues to accelerate the process of woundhealing and tissue repair. Circulating monocytes enter the wound andmature into macrophages and dendritic cells. They secrete interferon-γ(IFNγ), and angiogenic and fibrogenic growth factors. These factors andadditional chemokines, cytokines and growth factors are produced afterdebridement of the injured tissue and are instrumental in the removal ofdead cells, localized recruitment of fibroblasts and mesenchimal stemcells, cell proliferation and tissue remodeling to effect wound healing.This tissue repair process occurs in infected wounds, surgicalincisions, burns and other traumatized tissues as disclosed in Rappoleeet al., Curr. Top. Microbiol. Immunol. 181, 87 (1992); Nathan, J. Clin.Invest. 79, 319 (1987) and Singer et al., New England Journal ofMedicine 341, 738 (1999), all of which are hereby incorporated byreference. Major chemoattractants directing migration of neutrophils,monocytes and macrophages are the C5a and C3a fragments of thecomplement components C5 and C3, which are generated followingcomplement activation by antigen/antibody interactions. Thesechemotactic factors form a concentration gradient that guides themigration of neutrophils, monocytes and macrophages to the areas withincreased concentrations of C5a and C3a.

In some embodiments, the present invention provides for compositions andmethods for the recruitment and activation of large numbers ofneutrophils, monocytes and macrophages into wounds by local injection ofliposomes possessing multiple α-gal epitopes (Galα1-3Galβ1-4GlcNAc-R orGalα1-3Galβ1-3GlcNAc-R) on their glycolipid components, or by topicalapplication of ointment containing α-gal glycolipids. The α-gal epitopesbind the natural anti-Gal antibody, which is the most abundant antibodyin humans. This antigen/antibody interaction in turn activatescomplement forming the degradation products C5a and C3a that serve aseffective chemoattractants for inflammatory cells.

II. Anti-Gal Antibodies And α-Gal Epitopes

Anti-Gal is an abundant natural antibody in humans constituting ˜1% ofall serum immunoglobulins as provided for in Galili et al., J. Exp. Med.160, 1519 (1984), incorporated herein by reference. This antibodyinteracts specifically with the α-gal epitope (Galα1-3Galβ1-4GlcNAc-R orGalα1-3Galβ1-3GlcNAc-R) on glycolipids and glycoproteins as disclosed inGalili, Springer Semin. Immunopathol. 15, 155 (1993), incorporated inits entirety by reference. Anti-Gal is produced throughout life as aresult of antigenic stimulation by bacteria of the gastrointestinaltract as described in Galili et al., Infect. Immun. 56, 1730 (1988). Theα-gal epitope is synthesized by the glycosylation enzymeα-1,3-galactosyltransferase (α1,3GT) and expressed in very large amountson the cells of non-primate mammals, prosimians and in New World monkeysas provided for in Galili et al., J. Biol. Chem. 263, 17755 (1988),incorporated herein by reference. The α1,3GT gene was inactivated inancestral Old World primates. Thus humans, apes, and Old World monkeyslack α-gal epitopes and produce high titer anti-Gal antibodies asprovided for in Galili et al., J. Biol. Chem. 263, 17755 (1988),incorporated herein by reference. Anti-Gal antibodies bind in vivo toα-gal epitopes when administered to humans or Old World monkeys. This isparticularly evident in the context of xenotransplantation, where the invivo binding of anti-Gal to α-gal epitopes on transplanted pig heart orkidney is the main cause for the rapid rejection of such grafts inhumans and Old World monkeys as disclosed in Galili et al., Immunol.Today 14, 480 (1993) and Collins et al., J. Immunol. 154, 5500 (1995),both of which are incorporated in their entirety by reference.

One of the main mechanisms mediating xenograft rejection is theactivation of the complement cascade due to anti-Gal binding to α-galepitopes on the endothelial cells of the xenograft. This results in thedestruction of these endothelial cells by the activated complementmolecules, causing collapse of the vascular bed and xenograft ischemiafollowed by its rapid rejection as provided for in Collins et al., J.Immunol. 154, 5500 (1995), hereby incorporated by reference. This insitu interaction of anti-Gal with newly introduced α-gal epitopes can beexploited for local activation of the complement system and recruitmentof neutrophils, monocytes and macrophages into damaged tissues toaccelerate the inflammatory response and subsequent tissue repair. Dueto its ubiquitous production in humans, anti-Gal is a superior choicefor this purpose.

III. Binding of Anti-Gal Antibody by α-Gal Liposome

Recruitment of neutrophils, monocytes and macrophages into sites ofinfection or tissue damage is directed by a concentration gradient offragments of activated complement molecules such as C5a and C3a.Injection of molecules or particulate material bearing α-gal epitopes iscontemplated to result in local interaction between endogenous anti-Galantibodies and the exogenous α-gal epitopes, followed by activation ofthe complement system. One example of particulate material carryingmultiple α-gal epitopes is α-gal liposomes, which can be prepared fromchloroform:methanol extracts of rabbit red blood cell (RBC) membranes asshown in FIGS. 1 and 2. These liposomes are comprised of rabbit RBCglycolipids, phospholipids and cholesterol. Since most rabbit RBCglycolipids have α-gal epitopes, these liposomes carry many of theseepitopes. When the α-gal liposomes are injected intradermally or intoother tissues, a high local concentration of α-gal epitopes isgenerated, which is available for binding to anti-Gal antibodies. Boththe anti-Gal antibody and complement are contemplated to reach theinjection site due to local rupture of capillaries by the injectingneedle. The activation of complement and generation of C5a and C3afragments, following anti-Gal interaction with α-gal epitopes, resultsin a local inflammatory reaction that induces capillary dilation, andaccumulation of serum proteins at the injection site (including moreanti-Gal and complement proteins). This leads to further binding ofanti-Gal to the injected α-gal liposomes and activation of complement,ultimately resulting in an amplification of the inflammatory process andthe increased formation of chemotactic factors for recruit of additionalneutrophils, monocytes and macrophages into the injection site. Otherliposomes that bear α-gal epitopes or other molecules carrying one orseveral α-gal epitopes are also suitable for enhancing the beneficialinflammatory response occurring at the injection site.

The monocytes/macrophages migrating into the injection site bind theanti-Gal coated (opsonized) α-gal liposomes via their Fcγ receptors(FcγR). The interaction of the Fc portion of anti-Gal (upon opsonizationof α-gal liposomes) with FcγR on the monocyte and immature macrophagecell surface induces the activation of these cells and thedifferentiation of the monocytes into mature macrophages. Activatedmacrophages have been shown to secrete a variety of growth factors andcytokines including for instance: vascular endothelial cell growthfactor (VGEF), epidermal growth factor (EGF), fibroblast growth factor(FGF), insulin-like growth factor (IGF), IL-1 and IL-6 as disclosed inDiPietro, Shock 4, 233-40 (1995); Rappolee et al., Curr. TopicsMicrobial Immunol. 181, 87-140 (1992) and Singer et al., New EnglandJournal of Medicine 341, 738-46 (1999), all of which are herebyincorporated by reference.

The effect of α-gal liposomes on recruitment of macrophages and woundhealing is localized to the injection site and has little to no systemiceffect. The three components of the exemplary α-gal liposomes, α-galglycolipids, phospholipids and cholesterol, are not immunogenic andtherefore do not elicit a de novo immune response presumably becausephospholipids and cholesterol are found in all mammalian species andbecause α-gal glycolipids in and of themselves do not activate T cellsas disclosed in Tanemura et al., J. Clin. Invest. 105, 301 (2000).Accordingly, analysis of the antibody response to α-gal liposomes byELISA (using α-gal liposomes as the solid phase antigen) revealed thatantibody titers to α-gal liposomes were not elevated at 35 or 40 dayspost-injection. Moreover in experiments performed in anti-Galseropositive mice, administration of α-gal liposomes did not causeabnormal behavior post-injection or increased morbidity or mortality.

Thus, injection of a preparation of α-gal liposomes in water, saline orother excipient into an infected wound, is contemplated to result inanti-Gal binding, activation of complement, generation chemotacticfactors, rapid recruitment of neutrophils followed by monocytes andmacrophages, phagocytosis of the infectious agent, debridement of thewound, and migration of fibroblasts into the wound. Secretion ofepithelial growth factor by the activated macrophages results inepithelization, e.g. proliferation of epithelial cells to close thewound. The destruction of infectious agents and debridement of the woundby the inflammatory cell infiltrate and subsequent migration offibroblasts and proliferation of epithelial cells is contemplated toaccelerate wound healing and tissue repair.

A similar accelerated healing of wounds can be achieved by topicalapplication of α-gal ointment onto injured skin areas of various woundsincluding burns as shown in FIG. 9. The α-gal epitopes of α-galglycolipids within this ointment bind the anti-Gal antibody, activatecomplement, generate complement degradation factors C5a and C3a due tocleavage of complement molecules, recruit granulocytes, monocytes andmacrophages to the treated site and thus, induce accelerated healing ofthe injured area.

IV. Wound Healing Applications

The compositions and methods of the present invention are suitable fortreating various wounds in normal subjects and in subjects havingimpaired healing capabilities, such as diabetics, heart disease and/orcardiac surgical subjects, and aged subjects.

In a preferred embodiment, compositions comprising α-gal liposomes areused to enhance wound healing in surgical incision sites that have beendamaged as a result of ischemia. Injection of α-gal liposomes into thearea surrounding the sutures and ischemic tissue enhances recruitment ofneutrophils, monocytes and macrophages into the surgical incision siteultimately resulting in improved wound healing. In this way, the presentinvention is suitable for shortening the time required for healing ofwounds and repair of damaged tissues following surgery. A specificnon-limiting example is the removal of a colon carcinoma andreconnection of the colon wall at the site of tumor resection.

In another embodiment, compositions comprising α-gal liposomes are usedto treat tissue. While not limiting the scope of the invention in anyway, one example contemplated by the invention is the treatment ofskeletal muscle damaged due to physical trauma or heart muscle damageddue to ischemia. Injection of α-gal liposomes into the injured ordamaged muscle tissue enhances recruitment of neutrophils, monocytes andmacrophages into the injured muscle ultimately resulting in improvedtissue repair. In particular the inflammatory cell infiltrate recruitsmyoblasts, which subsequently differentiate into functional cardiacmyocytes in treated heart muscle, or fuse and differentiate intofunctional skeletal muscle fibers in treated skeletal muscle. In thisway the biomechanical function of the damaged muscle is restored.

Moreover, injection of α-gal liposomes into nerves damaged by physicalor other trauma, or because of nerve degeneration, enhances recruitmentof neutrophils, monocytes and macrophages. The activated macrophagesdebride the damaged nerve tissue and secrete nerve growth factors thatinduce axonal regeneration and restoration of nerve pulse conductivityvia the regenerating nerve. This is contemplated to result in partial orcomplete restoration of function of the treated nerve.

In some embodiments, the invention relates to the use of α-gal liposomesin wound care devices for aged subjects in order to induce effectivewound healing by local activation of complement as a result of anti-Galantibody binding to α-gal lipososmes. In still another embodiment, theinvention relates to the use of α-gal liposomes in wound care devicesapplied to a wound in a subject following trauma. While not limiting thescope of the present invention, one example of a use for the presentinvention is the treatment of a subject recovering from a car accidentresulting in injuries to said subject.

In further embodiments, compositions comprising α-gal glycolipids and/orα-gal epitopes are applied to skin burns. Their interaction with theanti-Gal antibody, leaking to the burn surface together with other serumproteins, results in complement activation recruitment of neutrophils,monocytes and macrophages and ultimately resulting in acceleratedhealing of the burn.

In an additional embodiment, the disclosed α-gal liposome can becombined in compositions with at least one anti-Gal antibody. Themixture of these antigen and antibody will result in increasedrecruitment of neutrophils, monocytes and macrophages to the injuredarea. Such treatment is ideal, for example, for aged individuals orsubjects with advanced diabetes patients where poor vascularizationprevents sufficient anti-Gal antibody from reaching injured areas.Alternatively, such treatment may be applicable to non-primate mammalslacking the anti-Gal antibody. The applied immune complexes activatecomplement and thus accelerate wound healing.

In some embodiments, the local anti-Gal mediated activation ofcomplement and subsequent recruitment of activated macrophages into aninjection site is achieved by employing a variety of natural orsynthetic macromolecules carrying multiple α-gal epitopes. Variouscommercially available glycolipids (Dextra Laboratories, Ltd., UnitedKingdom) are suitable for use in the compositions and methods of thepresent invention for generation of α-gal liposomes. These glycolipidsinclude but are not limited to: i) Galα-3Gal glycolipids: α1-3galactobiose (G203); linear B-2 trisaccharide (GN334); and Galilipentasaccharide (L537). Various other glycoconjugates with α-galepitopes available from Dextra include for instance:Galα1-3Galβ1-4Glc-BSA (NGP0330); Galα1-3Galβ1-4(3-deoxyGlcNAc)-HAS(NGP2335); Galα1-3Galβ1-4GlcNAcβ1-HDPE (NGL0334); and Galα1-3Gal-BSA(NGP0203). Several non-limiting examples of additional macromoleculeswith α-gal epitopes that are suitable for injection and subsequent insitu binding to anti-Gal antibodies and local activation of complementinclude: mouse laminin with 50-70 α-gal epitopes as disclosed in Galili,Springer Seminars in Immunopathology 15, 155 (1993), incorporated hereinby reference; multiple synthetic α-gal epitopes linked to BSA asdisclosed in Stone et al., Transplantation 83, 201 (2007), herebyincorporated by reference; GAS914 produced commercially by Novartis anddisclosed in Zhong et al., Transplantation 75, 10 (2003), incorporatedherein by reference; the α-gal polyethylene glycol conjugate TPC asdisclosed in Schirmer et al., Xenotransplantation 11, 436 (2004), herebyincorporated by reference, and α-gal epitope-mimicking peptides linkedto a macromolecule backbone as disclosed in Sandrin et al., Glycoconj.J. 14, 97 (1997), hereby incorporated by reference. Injection or topicalapplication of such macromolecules results in local interaction with thepre-formed anti-Gal antibody present in all humans, activation ofcomplement, recruitment of inflammatory cells into the injection siteand differentiation of these cells thereby effecting improvements in theduration and quality of wound healing.

In still further embodiments a glycoprotein carrier such as the humanalpha1-acid glycoprotein (α1-AG) is utilized. α1-AG is abundant in humanserum, non-immunogenic in humans, and can be obtained commercially inpurified form. α1-AG is a small glycoprotein (e.g., 40 kDa) with fiveN-linked carbohydrate chains, each with 2 or more antennae with theterminal structure sialic acid-Galβ1-4GlcNAc-R as disclosed in Schmid etal., Biochemistry 13, 2694-2697 (1973), incorporated herein byreference. To synthesize the α-gal epitopes on the α1-AG the sialic acidis first removed to expose the penultimate N-acetyllactosamine(Galβ1-4GlcNAc-R). Next the appropriate carbohydrate is added to thisbackbone to synthesize the α-gal epitope. Briefly, neuraminidase is usedto remove the terminal sialic acid, followed by the addition of anα1-3Gal unit using a galactosyltransferase (e.g., recombinant α1,3galactosyltransferase) and uridine diphosphate-galactose as the sugardonor as disclosed in Galili, Cancer Immunol. Immunother. 53, 935-945(2004), hereby incorporated by reference.

V. Cardiac Tissue Damage

In preferred embodiments, the compositions and methods of the presentinvention are used to promote healing due to cardiac tissue damage inboth normal subjects and in subjects having impaired healingcapabilities. For example, the heart is comprised of cardiac tissue.This tissue may be damaged or otherwise compromised during cardiactrauma, disease or related events including but not limited to cardiacsurgery, coronary heart disease, cardiomyopathy, cardiovascular disease,ischemic heart disease, heart failure, hypertensive heart disease,inflammatory heart disease and valvular heart disease. Mortality ratesfor cardiac surgical procedures continue to be a cause for concern. Forexample, repairs of congenital heart defects are currently estimated tohave 4-6% mortality rates. One non-limiting example of wounds that mayreceive benefit from the compositions and methods of the presentinvention are infected deep sternum incisions that are observed in anappreciable number of open-heart surgery patients. Injection of α-galglycolipid preparations (e.g., α-gal liposomes) into the infected areaof the sternum enhances recruitment of neutrophils, monocytes andmacrophages into the surgical incision site ultimately resulting inimproved wound healing.

VI. Osteoarthritis (OA)

In preferred embodiments, the methods and compositions of the presentinvention are used to reduce the symptoms associated with osteoarthritis(OA), a disease that may also be referred to as degenerative arthritis.Traditionally, treatment for osteoarthritis is limited to pain relieversincluding but not limited to non-steroidal anti-inflammatory drugs(NSAIDS), corticosteroids, COX-2 selective inhibitors and topicalcreams. In more severe cases of OA the subject receives eitherinjections of local anesthetics such as lidocaine or undergoes jointreplacement surgery for the affected area. In a further embodiment,injection of α-gal liposomes into the synovial cavity, or into damagedcartilage within injured bones enhances recruitment of neutrophils,monocytes and macrophages into the synovial cavity or cartilageultimately resulting in tissue repair. In particular, macrophagesactivated by the binding of α-gal liposome/anti-Gal antibody complexesmediate debridement of the damaged cartilage and through secretion ofgrowth factors and cytokines direct migration of chondroblasts into thedamaged cartilage. The chondroblasts in turn secrete collagen and othercartilage matrix proteins and polysaccharides, resulting in repair andremodeling of the damaged articular or meniscus cartilage within thetreated joint. Similarly, macrophages activated by the binding of α-galliposome/anti-Gal antibody complexes mediate debridement of the damagedbone and through secretion of growth factors and cytokines recruitosteoclasts and osteoblasts into the injection site for repair andremodeling of the damaged bone.

In a further embodiment, injection of α-gal liposomes into the synovialcavity, or into damaged cartilage within injured bones enhancesrecruitment of neutrophils, monocytes and macrophages into the synovialcavity or cartilage ultimately resulting in tissue repair. Inparticular, macrophages activated by the binding of α-galliposome/anti-Gal antibody complexes mediate debridement of the damagedcartilage and through secretion of growth factors and cytokines directmigration of chondroblasts into the damaged cartilage. The chondroblastsin turn secrete collagen and other cartilage matrix proteins andpolysaccharides, resulting in repair and remodeling of the damagedarticular or meniscus cartilage within the treated joint. Similarly,macrophages activated by the binding of α-gal liposome/anti-Gal antibodycomplexes mediate debridement of the damaged bone and through secretionof growth factors and cytokines recruit osteoclasts and osteoblasts intothe injection site for repair and remodeling of the damaged bone.

VII. Diabetes

In preferred embodiments, the present invention is used to promotehealing in tissue damage as a result of diabetes in both normal subjectsand in subjects having impaired healing capabilities. Diabetes can causemany complications, including but in no way limited to acutecomplications such as hypoglycemia, ketoacidosis, or non-ketotichyperosmolar coma, long-term complications including but not limited tocardiovascular disease, chronic renal failure, retinal damage,blindness, nerve damage and microvascular damage. Poor healing of manysuperficial wounds due to diabetes can lead to many diseases includingbut not limited to gangrene, which may require amputation. In thedeveloped world, diabetes is the most significant cause of adultblindness in the non-elderly and the leading cause of non-traumaticamputation in adults, and diabetic nephropathy is the main illnessrequiring renal dialysis in the United States. The α-gal liposomes ofthe present invention may be preferably used in wound care devices inpatients with diabetes, in order to induce effective wound healing bylocal activation of complement as a result of anti-Gal antibody bindingto α-gal liposomes. In still another embodiment, the invention relatesto the use of α-gal liposomes in wound care devices applied to a woundin a subject following either diabetic complications or the naturalprogression of the disease.

EXPERIMENTAL

The following examples are provided in order to demonstrate and furtherillustrate certain preferred embodiments and aspects of the presentinvention and are not to be construed as limiting the scope thereof.

In the experimental disclosure which follows, the followingabbreviations apply: kDa (kilodalton); rec. (recombinant); N (normal); M(molar); mM (millimolar); μM (micromolar); mol (moles); mmol(millimoles); μmol (micromoles); nmol (nanomoles); pmol (picomoles); g(grams); mg (milligrams); μg (micrograms); ng (nanograms); l or L(liters); ml (milliliters); μl (microliters); cm (centimeters); mm(millimeters); μm (micrometers); nm (nanometers); C (degreesCentigrade); α1,3GT (α1,3galactosyltransferase); BSA (bovine serumalbumin); ELISA (enzyme linked immunosorbent assay); HRP (horseradishperoxidase) IFNγ (interferon-γ); knockout (KO); mAb (monoclonalantibody); OD (optical density); OPD (ortho phenylene diamine); PBS(phosphate buffered saline); RBC (rabbit red blood cells);

Example 1 Production of α-Gal Liposomes and Binding of Anti-Gal

Exemplary α-gal liposomes are generated from extracts of rabbit redblood cell (RBC) membranes. These membranes are used since they containglycolipids carrying from one to more than seven α-gal epitopes permolecule as disclosed in Eto et al., Biochem. (Tokyo) 64, 205, (1968);Stellner et al., Arch. Biochem. Biophys. 133, 464 (1973); Dabrowski etal., J. Biol. Chem. 259, 7648 (1984) and Hanfland et al., Carbohydr.Res. 178, 1 (1988), all of which are hereby incorporated by reference.However, α-gal liposomes may be produced from any natural or syntheticsource of α-gal glycolipids upon addition of phospholipids in thepresence or absence of cholesterol, after processing as describedherein. As a non-limiting example, rabbit RBC are used at a volume of0.25 liter packed cells. The RBC are lysed by repeated washes withdistilled water. The rabbit RBC membranes are then mixed with a solutionof 600 ml chloroform and 900 ml methanol for 20 h with constant stirringto dissolve the membrane glycolipids, phospholipids and cholesterol intothe extracting solution. In contrast, proteins are denatured and areprecipitating within and upon the membranes. Subsequently, the mixtureis filtered to remove non-solubilized fragments and denatured proteins.The extract contains the rabbit RBC phospholipids, cholesterol andglycolipids, dissolved in the organic solution of chloroform andmethanol (FIG. 2A). With the exception of the glycolipid ceramidetri-hexoside (CTH) having the structure Galα1-4Galβ1-4Glc-Cer, theglycolipids extracted from rabbit RBC membranes generally have 5 to morethan 25 carbohydrate units in their carbohydrate chains with one orseveral branches, all of which are capped with α-gal epitopes. RabbitRBC glycolipids were also reported to have 30, 35 and even 40carbohydrate units with α-gal epitopes on their branched carbohydratechains as provided for in Honma et al., J. Biochem. (Tokyo) 90, 1187(1981), incorporated in its entirety by reference. The extractcontaining glycolipids, phospholipids and cholesterol is subsequentlydried in a rotary evaporator. The amount of dried extract isapproximately 300 mg per 0.25 liter of packed rabbit RBC.

Thirty ml of saline is added to the dried extract, which is thensubjected to sonication in a sonication bath. This sonication processresults in conversion of the extract into liposomes comprised of α-galglycolipids, phospholipids and cholesterol, as schematically illustratedin FIG. 1A. The α-gal liposomes have a size in the range of 0.1-20 μm,with the average size controlled by the length and intensity of thesonication process. Because the α-gal epitopes of many of the α-galglycolipids protrude out of the liposomes, these epitopes readilyinteract with anti-Gal antibodies. This interaction results inactivation of the complement cascade by anti-Gal binding to α-galliposomes and the generation of C5a and C3a complement fragments, whichin turn, form a chemotactic gradient that directs the migration ofneutrophils, monocytes and macrophages from the circulation and from theperi-vascular space into the site of the α-gal liposome depot. Theinflammatory cell infiltrate is readily observed in the histologicalsections of FIG. 6. The neutrophils and macrophages are capable ofdestroying microbial agents such as bacteria, viruses or fungi in theregion of the injected α-gal liposomes. Macrophages have Fcγ receptors(FcγR) that bind to the Fc portion of IgG molecules that have bound toantigen. In this way, anti-Gal IgG molecules that bind to α-gal epitopeson the α-gal liposomes, also bind to FcγR on the recruited macrophages,as schematically illustrated in FIG. 1B. This interaction results inactivation of the macrophage, internalization of the α-gal liposomes andsecretion of a wide variety of growth factors, cytokines and chemokinesto orchestrate the healing and remodeling of damaged tissue in part byrecruiting fibroblasts and mesenchimal stem cells and stimulateproliferation of epithelial cells.

The specific binding of anti-Gal of human and mouse origin to theexemplary α-gal liposomes is graphically depicted in FIG. 3.Specifically, FIG. 3A shows the binding of anti-Gal to α-gal liposomesin suspension. When tested for binding to synthetic α-gal epitopeslinked to bovine serum albumin (α-gal BSA) as solid-phase antigen,binding at a level higher than 1.0 optical density (OD) could beobserved at serum dilutions of up to 1:80. However, if the serum waspre-incubated for 2 h at 37° C. with 10 mg/ml of α-gal liposomes,subsequent binding to the solid-phase α-gal BSA was less than 1.0 ODeven at the lowest serum dilution of 1:10. This indicates that much ofthe serum anti-Gal binds to α-gal liposomes in suspension and thereforeit is neutralized and is unavailable for the subsequent binding to theα-gal BSA as solid-phase antigen in the ELISA.

Similarly FIG. 3B shows the binding of human and mouse anti-Gal to α-galliposomes that serve as a solid-phase antigen in an ELISA. The α-galliposomes were plated as 50 μl aliquots of a 100 μg/ml suspension inphosphate buffered saline (PBS) in ELISA wells and dried overnight. Thedrying results in the firm adhesion of the α-gal liposomes to the wells.The wells were subsequently blocked with 1% BSA in PBS. Human serum,α1,3galactosyltransferase (α1,3GT) knockout (KO) mouse serum containinganti-Gal antibody, and mouse monoclonal anti-Gal as disclosed in Galiliet al., Transplantation 65, 1129 (1998), hereby incorporated byreference, were added to the wells. The α1,3GT KO mouse serum containsanti-Gal antibodies upon immunization of the mouse with pig kidneymembranes as provided for in Tanemura et al., J. Clin. Invest. 105, 301(2000), hereby incorporated by reference. After 2 h incubation, thewells were washed and binding of anti-Gal to α-gal liposomes wasdetermined by the addition of the corresponding horseradish peroxidase(HRP) coupled anti-human, or anti-mouse secondary antibody followed bycolor reaction with ortho phenylene diamine (OPD). Anti-Gal readilybinds to α-gal liposomes, with 1.0 OD value at a serum dilution of 1:160(●). The specificity of the anti-Gal/α-gal liposome interaction wasdemonstrated be eliminating anti-Gal binding upon treatment of the α-galliposomes coating the ELISA wells with recombinant α-galactosidase asdisclosed in Stone et al., Transplantation 83, 201 (2007), incorporatedherein by reference (◯). The α-galactosidase enzyme cleaves the terminalgalactose unit from the α-gal epitope, thereby destroying this epitope.Following such enzymatic treatment, the binding of anti-Gal to theliposomes could not be detected. The anti-Gal specific binding to α-galliposomes was also demonstrated using serum from immunized KO mice (▪),whereas treatment of the α-gal liposomes with α-galactosidase eliminatedanti-Gal binding (□). Specific binding of α-gal epitopes by α-galliposomes was also observed using an anti-Gal mAb from hybridoma cellsupernatants (♦). As expected, the anti-Gal mAb did not bind to α-galliposomes after treatment with α-galactosidase (⋄). Similar specificbinding to α-gal liposomes was observed with the α-gal epitope reactivelectin Bandeiraea simplicifolia IB4 (BS lectin) (▴) as provided for inWood et al., Arch. Biochem. Biophys. 198, 1 (1979), incorporated hereinby reference. The binding of this lectin was also abolished by treatmentwith α-galactosidase (Δ). These observations clearly demonstrate thatthe α-gal liposomes produced by sonication of chloroform/methanolextracts from rabbit RBC membranes, readily bind to anti-Gal antibodies.Although it is not necessary to understand the mechanism of aninvention, it is believed that binding of anti-Gal to α-gal liposomesoccurs in vivo at the injection site in subjects possessing anti-Galantibodies.

Example 2 Binding of Anti-Gal to α-Gal Liposomes Induces ComplementActivation

This example describes the activation of complement within serum as aresult of the binding of serum anti-Gal antibodies to α-gal epitopes onα-gal liposomes. Complement activation was observed herein by measuringthe consumption of complement (e.g., loss of complement ability to lysecells with bound antibodies). The binding of anti-Gal to α-gal epitopeson α-gal liposomes results in complement consumption due to conversionof the activated complement into complement fragments. The hybridomacell line M86, which secretes an anti-Gal mAb, was used as a readoutsystem for measuring complement mediated cytolysis (e.g., presence ofcomplement in the serum). Since M86 cells express α-gal epitopes, theanti-Gal IgM mAb they produce bind to the α-gal epitopes on thehybridoma cell surface as schematically illustrated in FIG. 4A. Whencomplement is added, it is activated by the anti-Gal bound to α-galepitopes on the M86 cells, ultimately resulting in complement mediatedlysis of the M86 cells as provided for in Galili et al., Transplantation65, 1129 (1998), hereby incorporated by reference. Incubation of M86cells with human serum at various dilutions, for 1 h at 37° C. (●)results in more than 40% lysis of the M86 cells even at a serum dilutionof 1:64 (FIG. 4B). Lysis of M86 cells does not require exogenousanti-Gal since these cells have autologous anti-Gal bound to the α-galepitopes of the cell surface. Thus, human serum depleted of anti-Galalso induces M86 lysis, due to the complement activity present in humanserum (◯). Anti-Gal depletion can be achieved by incubation of the humanserum with glutaraldehyde fixed RBC, which express an abundance of α-galepitopes. The adsorption of anti-Gal on fixed rabbit RBC was performedon ice to prevent complement activation during the adsorption process.Rabbit serum (which lacks anti-Gal like serum from all other nonprimatemammals) has complement and thus can lyse more than 40% M86 cells evenat a dilution of 1:64. Incubation at 56° C. for 30 min of both humanserum (Δ) and rabbit serum (□) results in inactivation of complement andhence loss of lytic activity (FIG. 4B).

Addition of α-gal liposomes to the human serum diluted 1:10 for 30 minat 37° C., prior to addition of M86 cells, resulted in the loss ofcomplement mediated cytolysis of the M86 cells even at a concentrationof 62 μg/ml of the α-gal liposomes (FIG. 4C). Loss of lytic activity ispresumed to occur as a result of the consumption of serum complement dueto anti-Gal binding to α-gal liposomes. Thus, subsequent addition of M86cells and incubation of the mixture for 1 h at 37° C. results in nosignificant M86 cell cytolysis, whereas in the absence of α-galliposomes the complement in human serum lyses 100% of the M86 cells.Similarly, the complement in normal rabbit serum diluted 1:10 lyses morethan 95% of M86 cells. However if the rabbit serum is incubated withα-gal liposomes and with heat inactivated human serum, no significantM86 lysis is observed when these cells are added to suspensionscontaining 62 μg/ml of α-gal liposomes. This lack of cell lysis is theresult of the rabbit complement consumption due to the human anti-Galbinding to the α-gal liposomes and inactivation of the rabbitcomplement, prior to the addition of M86 cells. These data indicate thatbinding of anti-Gal to α-gal liposomes in vivo will also result incomplement activation and therefore to the generation of C5a and C3achemotactic factors, which is always part of the complement activationprocess.

Example 3 Induction of Monocyte and Macrophage Migration

This example describes the chemotactic gradient generated by complementactivation as a result of serum anti-Gal binding to α-gal liposomes. Thegeneration of complement C5a and C3a chemotactic factors was assessed bymonitoring the migration of monocytes and macrophages in a Boydenchamber. This system includes two chambers, a lower chamber containingserum mixed with α-gal liposomes and an upper chamber containing variouswhite blood cells. The two chambers are separated by a porous filterthat permits the migration of cells from the upper to the lower chambervia pores within the filter. At the end of a 24 h incubation period at37° C. the filters are stained and the number of migrating cells (e.g.,within lower chamber) is counted. The study was performed with 10⁶cells/ml in the upper chamber and serum diluted 1:5 (black columns) or1:10 (gray columns) and mixed with 1 mg/ml of α-gal liposomes in thelower chamber. A negative control solution in the lower chambercontained medium and α-gal liposomes, in the absence of serum, in orderto assess the random migration of cells (open columns). As shown in FIG.5, incubation of human peripheral blood lymphocytes (PBL) orpolymorphonuclear cells (PMN) in the upper chamber and α-gal liposomesin the absence of serum in the lower chamber did not induce significantcell migration. However when serum and α-gal liposomes were mixedtogether in the lower chamber, extensive migration of mononuclear cellsand neutrophils was observed toward the lower chamber. The morphology ofthe migrating cells in the PBL population indicated that the majority ofthe migrating cells were monocytes.

Example 4 Intradermal Recruitment of Neutrophils, Monocytes andMacrophages

In vivo studies on the effect of α-gal liposomes were performed inα-1,3galactosyltransferase knockout (KO) mice as provided for in Thallet al., J. Biol. Chem. 270, 21437-21442 (1995), incorporated in itsentirety by reference, since these are the only non-primate mammalscapable of producing anti-Gal antibodies. All other non-primate mammalsexpress α-gal epitopes and thus do not produce anti-Gal antibodies. Inorder to monitor the in vivo effect of anti-Gal interaction withinjected α-gal liposomes, KO mice producing anti-Gal (e.g., KO micepre-immunized with 50 mg pig kidney membranes resulting in the inductionof anti-Gal titers similar to those observed in humans) were injectedintradermally with 1.0 mg α-gal liposomes in 0.1 ml saline.

Skin specimens from the injection site were obtained at different timepoints, fixed, stained with hematoxyllin-eosin (H&E) and inspected undera light microscope. FIG. 6A depicts normal skin prior to injection ofα-gal liposomes. The epidermis comprises of one to two layers ofepithelial cells. The dermis contains fibroblasts under the epidermallayer, fat cells as a deeper layer and an underlying narrow layer ofmuscle cells and fibroblasts. No inflammatory cells are observed in thenormal skin (×100). FIG. 6B depicts the skin 12 h after injection of 1.0mg α-gal liposomes. The intradermal injection site is identified as thearea with the least amount of cells, under the muscle cell layer. Notethat at this early time point the injection area is filled withneutrophils that surround the injected site both within the fat celllayer and within the side adjacent to the epidermis (×100). FIG. 6C alsodepicts the skin 12 h post-injection. The α-gal liposome depot of theinjection site is shown in the center of image, which is bordered on theleft by the fat cell layer. The α-gal liposome injection site has a lowdensity of dermal cells. However, by 12 h post-injection, the injectionsite has become populated by infiltrating inflammatory cells presumablyrecruited by the injected α-gal liposomes bind to anti-Gal antibody andcomplement activation. A higher magnification of the infiltrating cellswithin the fat cell area in FIG. 6D (×400) indicates that theinfiltrating cells are neutrophils. The extensive migration ofneutrophils into the α-gal liposome injection site is followed bymigration of monocytes and macrophages, which are recruited by thelocally produced complement chemotactic factors. FIG. 6E depicts theα-gal liposome injection site 48 h post-injection. As shown in thishigher magnification (×400) most of the infiltrating inflammatory cellsin the injection site are mononuclear cells with nuclear featuresresembling macrophages (e.g., kidney shaped nuclei). These cells areevident in the injection site already 24 h post-injection. Thecharacterization of these cells as macrophages is further described inExample 6 below. FIG. 6F depicts the α-gal liposome injection site 5days post-injection. By this time the injection site is filled withlarge round macrophages, reflecting the local activation of theinfiltrating macrophages due to the interaction of the anti-Galopsonized α-gal liposomes. Only the center of the injection site isdevoid of macrophages, and likely functions as an α-gal liposome depot.The epidermis in this figure is shown in the upper left corner. As shownin FIG. 6G, infiltrating macrophages are detectable in the injectionsite as late as 14 days post-injection. As shown in FIG. 6H, macrophagescompletely disappear from the injection site by day 20 post-injection.The injection site at that stage is rich with fibroblasts and musclecells, which are contemplated to have originated from myofibroblastsrecruited by the macrophages activated by the anti-Gal opsonized α-galliposomes. Nonetheless an understanding of the mechanism is notnecessary in order to make and use the present invention. Thehistological analysis presented in FIG. 6 indicates that intradermalinjection of α-gal liposomes is suitable for induction of a localinflammatory response. The localized inflammatory response is detectablewithin 12 h and is accompanied by extensive neutrophils infiltration,followed by a second wave of infiltrating monocytes and macrophageswithin 24-48 h post-injection. In skin wounds accompanied by microbialinfection, the neutrophils and the macrophages recruited by theinteraction between anti-Gal and the injected α-gal liposomes arecontemplated to mediate the destruction of the infectious agent. Inaddition, the various growth factors, cytokines and chemokines secretedby the activated macrophages are contemplated to mediate wound healingand repair of the damaged tissue. Nonetheless an understanding of themechanism(s) is not necessary in order to make and use the presentinvention.

Example 5 α-Gal Liposomes do not Elicit an Immune Response

Although α-gal liposomes readily bind in vitro and in vivo to anti-Galantibodies, they do not elicit an immune response against the injectedα-gal liposomes as determined by ELISA. To demonstrate this, 50 μl of asolution containing α-gal liposomes at a concentration of 100 μg/ml weredried in ELISA wells to serve as a solid phase antigen. Serum samplesfrom two representative mice obtained before (◯and □) and 35 days postintradermal injection (● and ▪, respectively) were tested for IgGbinding to α-gal liposomes. A humoral immune response against componentsof the α-gal liposomes should result in increased IgG binding to α-galliposome-coated wells in post-injection serum (e.g., higher activity ascompared to pre-injection serum). As shown in FIG. 7, the binding of IgGantibodies to α-gal liposomes 35 days post-injection was similar orlower to that observed prior to injection. Thus administration of α-galliposomes does not elicit a deleterious humoral immune response againstthe injected material, despite their ability to recruit neutrophils,monocytes and macrophages to the injection site.

Example 6 Recruitment of Macrophages into Polyvinyl Alcohol (PVA)Sponges by α-Gal Liposomes

The objective in this study was to determine whether the mononuclearcells recruited by injected α-gal liposomes binding the anti-Galantibody (FIG. 6) are macrophages that can be identified byimmunostaining and analysis of stained cells by flow cytometry. This wasperformed by the use of subcutaneously implanted polyvinyl alcohol (PVA)sponge discs (PVA Unlimited, Inc., 10 mm diameter and 3 mm thickness).Prior to implantation, the discs were soaked in a suspension of α-galliposomes (100 mg/ml). α1,3galactosyltransferase knockout mice (KO mice)were anaesthetized with 0.04 cc of ketamine/xylazine (50 mg/cc and 2.5mg/cc, respectively). The dorsa of the mice are shaved and a 10 mmlinear incision was made then implanted subcutaneously with the PVA discsoaked in α-gal liposome suspension. The wound was closed by suture. ThePVA discs were removed from the mice 72 h post implantation. The presentinvention teaches that anti-Gal binds to the α-gal liposomes, activatescomplement and recruit inflammatory cells into the PVA sponge discs. Thecells migrating in vivo into the PVA sponge discs were retrieved byrepeated pressing on sponge discs immersed in PBS. Subsequently, thecells were washed, stained with the mouse monoclonal anti-CD11bmacrophage specific antibody (Pharmingen Inc, CA) and subjected to flowcytometry (FACS). As shown in FIG. 8, all infiltrating cells were foundto be macrophages, since all cells displayed shift to the right afterstaining with anti-CD11b antibody (broken line) in comparison to isotypecontrol (solid line). Thus, all infiltrating cells were stainedpositively with the macrophage specific monoclonal antibody. PVA discssoaked with saline and studied 3 days post implantation contained nomeasurable numbers of infiltrating cells.

Example 7 Effects of α-Gal Ointment Application on Wound healing

The α-gal ointment is another composition containing α-glycolipids thatcan be used for accelerated wound healing by recruitment of macrophagesto the damaged area. It is of particular beneficial use in skin burns.The α-gal ointment is prepared by mixing α-gal glycolipids with Vaselineor any other cream or gel at a final concentration ranging from 0.001%to more than 90% α-gal glycolipids. The α-gal glycolipids may or may notbe purified from the mixture with phospholipids and cholesterol obtainedby extraction from rabbit red blood cell membranes (described in Example1). The α-gal ointment is applied topically onto such as, but notlimited to skin burns. Burns may be caused by various injuries (e.g.,hot objects, hot fluids or radiation). The illustration in FIG. 9describes treatment of a burn with α-gal ointment. This treatment isapplicable to other types of wounds as well. The natural anti-Galantibody and complement proteins are among the serum proteins that leakfrom the damaged blood vessels into the burn area because of their highconcentration in the serum. As illustrated in FIG. 9, the interaction ofthe natural anti-Gal antibody in the burn with the large amounts ofα-gal glycolipids in the ointment induces local activation of thecomplement cascade, and thus, generates the complement fragmentschemotactic fragments C5a and C3a that recruits macrophages to the areaof this antibody binding to its antigen. This extensive recruitment ofmacrophages, which is much faster than the physiologic migration ofmacrophages into burns, results in accelerated debridement,epithelialization, fibroblasts migration and proliferation and collagenmatrix deposition by the fibroblasts (fibroplasia), ultimately resultingin accelerated healing of burns and shorter morbidity than that achievedwith current treatments. This treatment is applicable to various skininjuries where anti-Gal will leak from damaged capillaries and thus willinteract with α-gal glycolipids within the applied α-gal ointment. α-Galointment may also be formed with ointments containing antibiotics (asthose presently used for burns treatment), thus preventing infectionswhile the healing process occurs. This treatment of topical applicationof α-gal glycolipids in an ointment formulation introduces no chemicals,other than the natural α-gal epitopes on glycolipids. Phospholipids andcholesterol, if present, are identical to those in human cells.Therefore, this treatment is likely to be safe. The safety of α-galglycolipids is further implied from the fact that humans are constantlyexposed to α-gal epitopes via a wide range of foods containing beef andpork meat, without any adverse effects.

Example 8 Binding of Anti-Gal to α-Gal Glycolipids in α-Gal Ointment

The interaction between the anti-Gal antibody and α-gal epitopes inα-gal ointment is demonstrated. The α-gal ointment can not be used assolid phase antigen in ELISA since it does not attach to ELISA wells.Thus, the accessibility of α-gal epitopes within the ointment toanti-Gal binding was tested by mixing of the monoclonal anti-Gal M86antibody as provide for in Galili et al., Transplantation 65, 1129,1998, hereby incorporated by reference, with the ointment at a 1:1 ratio(vol/vol) for 1 h at 37° C. Interaction of anti-Gal with α-gal epitopesin the ointment prevents (neutralizes) subsequent binding of themonoclonal anti-Gal antibody to α-gal epitopes on the synthetic α-galepitopes linked to bovine serum albumin (α-gal BSA), which serves assolid phase antigen in ELISA. This provides a readout system fornon-neutralized anti-Gal remaining active. Mixing the antibodypreparations with Vaseline served as control for lack of α-gal epitopes,i.e. no binding of anti-Gal. α-Gal ointment neutralized >95% of themonoclonal anti-Gal M86 antibody mixed with the ointment as shown inFIG. 10. In the absence of α-gal glycolipids, Vaseline had noneutralizing effect on anti-Gal. This implies that anti-Gal in burnareas will readily bind to α-gal epitopes in α-gal ointment that isapplied topically.

Example 9 Effect of α-Gal Ointment on Burn Healing Following ThermalInjury

This section demonstrates the effects of α-gal ointment on healing ofburns in α1,3galactosyltransferase knockout mice (KO mice) producing theanti-Gal antibody. KO mice were deeply anaesthetized withketamine/xylazine injection and a superficial skin burn was caused intwo sites on the back by brief touch with a heated end of a small metalspatula bend in the end (5 mm from the tip). Subsequently, α-galointment (FIG. 9) was applied topically to the right burn, whereas theleft burn was covered with Vaseline lacking α-gal glycolipids. The leftburn served as a control for healing of the burn in the absence ofanti-Gal interaction with α-gal epitopes. The wounds were covered withcircular band-aids. The mice (n=4) were euthanized on Day Six, the skinareas in the burn regions inspected and removed. The skin specimens werefixed with formalin and subjected to histological sections andhematoxyllin-eosin (H&E) staining (FIG. 11).

The burns were of the same size when formed by the heated edge of themetal spatula. However, after six days post-burn, the size of thedamaged area treated by topical application of α-gal ointment, wasapproximately half the size of the control wound treated with Vaseline(FIG. 11A). Histological analysis of the control Vaseline covered burnsrevealed the absence of the epithelial cells of the epidermis (FIG.11B). The presence of the debris comprised of dead tissue andgranulocytes (eschar) is evident as dark fragments above the injuredskin. A similar eschar is observed over the burn covered with α-galointment (FIG. 11C). However, the skin treated with α-gal ointment wascompletely covered at the burn area by a new epidermis consisting ofseveral layers of epithelial cells, as well as a keratinous layer overthis epithelial layer (stratum corneum) (FIG. 11C). These findingsindicate that within a period of six days, the topical application ofα-gal ointment results in complete regeneration of the top layer of theskin and the formation of an epidermis barrier that seals off the dermisfrom any microbial agent. It should be noted that at this early stage ofburn healing, no skin appendages (e.g. hair shafts or sweat glands) areobserved as yet. Overall, these findings imply that the histologicalanalysis fits the gross morphology findings of accelerated healing ofburns treated with α-gal ointment.

Example 10 Effects of α-Gal Liposome/Anti-Gal Antibody Application onRegeneration and Repair of Damaged Cartilage in Subjects withOsteoarthritis

This example is aimed to study the efficacy of the compositions andmethods of the present invention in recruitment of mesenchimal stemcells, or stem cells from any origin, for the healing and repair ofdamaged or injured tissues. In this example α-gal liposomes are injectedinto either the synovial cavity or the cartilage of human subjectshaving damaged articular cartilage in the joints, including but in noway limited to the knee joints of subjects with osteoarthritis. Theα-gal liposomes are injected at any volume that is suitable forinjection into the synovial cavity, with a preferred concentrationranging from 0.01 and 500 mg/ml. The injection is given once or severaltimes in interval of one to several weeks. The anti-Gal antibodyinteraction with α-gal epitopes on α-gal liposomes results in activationof complement and local production of the complement fragments C5a andC3a, which are potent chemotactics. These factors induce recruitment ofneutrophils, monocytes and macrophages into the synovial cavity or intocartilage, ultimately resulting in tissue repair. The Fcγ receptors onmacrophages bind the Fc portion of anti-Gal coating the α-gal liposomesdue to anti-Gal binding to α-gal epitopes on these liposomes. ThisFc/Fcγ receptor interaction generates a signal that activates themacrophages recruited by the C5a and C3a chemotactic factors. Activatedmacrophages mediate debridement of the damaged cartilage and throughsecretion of growth factors and cytokines direct migration of stem cellsthat differentiate locally into chondroblasts in the damaged cartilage.The chondroblasts in turn secrete collagen and other cartilage matrixproteins and polysaccharides, resulting in repair and remodeling of thedamaged articular cartilage within the treated joint. Similarly,macrophages activated by the binding of α-gal liposome/anti-Gal antibodycomplexes mediate debridement of the damaged bone and through secretionof growth factors and cytokines recruit osteoclasts and osteoblasts intothe injection site for repair and remodeling of the damaged bone. Byanalogy, similar injection of α-gal liposomes into damaged heart tissue(myocardium) will result in local recruitment of monocytes/macrophagesinto the injection site and the subsequent secretion of growth factorsand cytokines by these cells recruited into the injection sites. Thesegrowth factors and cytokines direct the migration of stem cells, eitherfrom the adjacent tissue or from another source, into the damaged tissueand further direct the subsequent repair and remodeling of the damagedheart tissue. Similarly, injection of α-gal liposomes into other damagedor inured tissues in the body may result in accelerated repair of theinjury by recruitment of stem cells by a mechanism similar to thatdescribed above for the damaged articular cartilage treated with α-galliposomes.

In summary, the present invention provides numerous advantages over theprior art, including methods and compositions for the improved woundhealing. All publications and patents mentioned in the abovespecification are herein incorporated by reference. Variousmodifications and variations of the described method and system of theinvention will be apparent to those skilled in the art without departingfrom the scope and spirit of the invention. Although the invention hasbeen described in connection with specific preferred embodiments, itshould be understood that the invention as claimed should not be undulylimited to such specific embodiments. Indeed, various modifications ofthe described modes for carrying out the invention which are obvious tothose skilled in diagnostics, cell culture, and/or related fields areintended to be within the scope of the present invention.

I claim:
 1. A method, comprising: a) providing; i) a subject havingendogenous anti-Gal antibody and a wound; and ii) a preparationcomprising an α-gal epitope having a terminal galactosyl; and b)applying said preparation to said wound to produce a treated wound. 2.The method of claim 1, wherein said terminal α-galactosyl is selectedfrom the group consisting of Galα1-3Gal and Galα1-6Gal.
 3. The method ofclaim 1, wherein said α-gal epitope is part of a molecule selected fromthe group consisting of a glycolipid, a glycoprotein, and aglycopolymer.
 4. The method of claim 3, wherein said glycolipidcomprises α-gal liposomes.
 5. The method of claim 1, wherein saidapplying is under conditions such that complement activation within oradjacent to said wound is enhanced.
 6. The method of claim 5, whereinsaid complement activation comprises production of C5a and C3a.
 7. Themethod of claim 1, wherein said applying is under conditions such thatneutrophil recruitment within or adjacent to said wound is enhanced. 8.The method of claim 1, wherein said applying is under conditions suchthat monocyte and macrophage recruitment within or adjacent to saidwound is enhanced.
 9. The method of claim 1, wherein said applying isunder conditions such that wound closure is accelerated.
 10. A method,comprising: a) providing; i) a subject having a wound; and ii) a woundcare device comprising a preparation comprising an α-gal epitope havinga terminal α-galactosyl, and an anti-Gal antibody; and b) applying saidwound care device to said wound to produce a treated wound.
 11. Themethod of claim 10, wherein said terminal α-galactosyl is selected fromthe group consisting of Galαa1-3Gal, and Galaα1-6GaI.
 12. The method ofclaim 10, wherein said α-gal epitope is part of a molecule selected fromthe group consisting of a glycolipid, a glycoprotein, and aglycopolymer.
 13. The method of claim 12, wherein said glycolipidcomprises a-gal liposomes.
 14. The method of claim 10, wherein saidpreparation is part of a wound care device selected from the groupconsisting of adhesive bands, compression bandages, gels, semipermeablefilms, and foams.